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(lijninaB  (llarrtngtnn.  fH.  0. 


Surgeon-in-charge  of  American  Hospital  and 
Training  School  for  Nurses 
Constantinople 


Read  at  a Reception  given  by 
UliBB  iHtUpr  (Soulft 

in  behalf  of  the  Hospital 
New  York,  March  26th,  J908 


::::'::TTES 

n.  Section 

y ' 


Amrriran  i^napital  au&  Olratntng 
^’rbnnl  for  Nitrsrs 
(Ennatanttnoglr,  Olurkrg 


(Incorporated  in  New  York  State) 


Home  Office : 

No.  105  East  22d  Street.  Room  818 
New  York 


William  Ives  Washburn,  President 
Henry  O.  Dwight,  LL. D.,  Vice-President 
James  S.  H.  Umsted,  Secretary 
Edwin  H.  Baker,  Treasurer 
Thomas  Spees  Carrington,  M.D., 
Surgeon-in-charge 


All  checks  should  be  made  payable  to 
Brown  Bros,  and  Co.,  Bankers. 

59  Wall  Street.  New  York 


MEDICAL  WORK  IN  TURKEY 

BY 

Thomas  Spees  Carrington,  IM.D. 

I want  to  bring  before  you  the 
great  importance  of  the  work  being 
done  at  the  present  time  by  Ameri- 
can medical  men  in  the  Turkish  Em- 
pire, and  so  that  you  may  understand 
clearly  the  position  they  fill  in  that 
country,  let  me  call  your  attention  io 
a few  of  the  peculiarities  of  the  state, 
the  people,  and  their  surroundings. 

Asia-Minor  is  divided  into  a se- 
ries of  plains  surrounded  by  moun- 
tain ranges.  These  plains  are  culti- 
vated by  peasants,  and  each  plain 
usually  supports  one  large  city  of 
from  twenty-five  to  a hundred  thou- 
sand inhabitants,  and  from  ten  to  two 
hundred  and  fifty  villages,  where  the 
peasants  live  together  for  protection. 

The  total  population  of  Asia-Minor 
is  about  ten  millions,  and  its  area  is 
over  two  hundred  and  seventy  thou- 
sand square  miles.  This  vast  country 
is  one  of  the  garden  spots  of  the 
world,  and  under  its  mild  climate  and 
a system  of  irrigation  which  has  been 
in  use  for  hundreds  of  years  the  peas- 


I 


ants  produce  fine  grains  and  the 
choicest  fruits. 

The  traveling  is  done  in  wagons, 
upon  ox-carts  or  on  horseback,  and 
patients  arriving  at  our  hospitals 
have  often  completed  a journey  of 
from  one  to  three  weeks  across  these 
plains  and  over  the  mountains  in 
search  of  surgical  assistance.  The 
people  are  kindly,  hospitable,  and 
great  lovers  of  children,  and  except 
when  aroused  and  excited  by  fanati- 
cal religious  teachers,  are  obedient  to 
the  laws,  and  peacefully  follow  their 
occupations. 

The  towns  and  cities  are  very  old, 
and  stand  upon  sites  which  have 
served  for  this  purpose  for  ages,  and 
as  often  has  been  the  case,  succeed- 
ing cities  have  been  built  upon  the 
ruins  of  their  predecessors.  This  cus- 
tom, while  very  convenient  for  the 
archaeologist,  has  been  a great  source 
of  danger  from  a sanitary  point  of 
view  to  the  inhabitants.  The  ground 
is  permeated  with  filth  to  a great 
depth,  and  the  wells  are  often  in- 
fected with  typhoid  or  other  disease 
germs. 

Where  it  is  possible,  the  water 
supply  of  the  town  is  conducted 
through  earthenware  pipes,  some- 
times many  miles  across  the  plains 


from  mountain  streams.  This  would 
be  ideal,  if  it  were  not  for  the  fact 
that  villages  are  often  built  over  the 
water  courses  and  the  pipes  opened 
for  their  local  supply.  The  peasants 
not  only  use  this  for  drinking,  but  I 
have  seen  them  washing  their  clothes 
in  the  pools  formed  over  these  open- 
ings. 

The  thoroughfares  of  all  Turkish 
towns  are  swarming  with  dogs.  They 
live  the  year  round  without  shelter, 
in  the  same  street  in  which  they  were 
born,  and  where  no  doubt  their  an- 
cestors lived  before  them  for  past 
centuries.  There  seems  to  be  some 
unwritten  law  among  them  appor- 
tioning the  different  blocks  to  each 
band,  for  if  the  invisible  line  between 
two  ouarters  is  overstepped  bv  even 
one  dog.  he  is  considered  a trespasser 
and  pitched  upon  by  all  near-by  ani- 
mals in  the  abutting  district.  His 
friends  then  come  to  his  assistance, 
which  starts  a general  battle  often 
heard  over  the  entire  city. 

The  streets  are  narrow,  crooked 
and  ill-paved  with  round  cobble  stones 
or  unpaved  and  covered  deep  with 
mud  and  standing  pools  of  water. 
This  is  due  to  the  open  sewers,  run- 
ning down  the  centers  of  the  thor- 
oughfares, and  keeps  up  the  reputa- 


3 


tion  for  odors  that  Oriental  countries 
have  so  justly  earned. 

Ventilation  of  the  houses  is  un- 
known, and  the  cracks  surrounding 
window  sashes  are  stuffed  with  paper 
or  other  material  during  the  winter, 
while  rooms  are  heated  with  charcoal 
braziers.  When  making  professional 
calls  at  night,  I have  often  seen  ten 
or  fifteen  persons  sleeping  on  the 
floor  in  one  room. 

There  is  no  inspection  of  cattle  or 
milk;  health  regulations  are  not  car- 
ried out,  or  quarantine  imposed  for 
contagious  diseases.  Cases  of  small- 
pox can  be  seen  on  the  streets  and 
tuberculosis  takes  its  toll  from  nearly 
every  household. 

Physical  culture  and  hygiene  are 
unknown,  and  the  people  sleep  in  the 
clothing  they  wear  during  the  day. 
Meals  are  prepared  at  irregular  hours 
and  eating  from  one  general  dish, 
with  the  fingers,  is  a common  cus- 
tom. Babies  are  often  left  lying  with 
faces  upturned  to  the  sun  and  no  one 
thinks  to  drive  the  flies  away  from 
their  little  eyelids,  while  eye  diseases 
are  producing  blindness  in  thousands 
of  Turkish  children  every  year.  This 
is,  perhaps,  the  chief  reason  for  this 
scourge,  as  the  people  have  no  idea 
that  flies  carry  contagion. 


4 


I have  often  been  told  by  the 
women  that  there  was  no  hope  of  sav- 
ing a baby  if  the  mother  could  not 
nurse  it,  as  the  children  fed  by  other 
methods  always  die.  When  babies 
are  old  enough  to  hold  things  in  their 
hands,  green  cucumbers  are  often 
given  them  to  play  with  and  bite 
upon.  Swaddling  clothes  are  gen- 
erally used  in  Turkey  and  Syria,  and 
while  very  picturesque,  are  extremely 
unhealthy  and  often  produce  disease 
and  deformity. 

These  are  a few  of  the  commonest 
ways  in  which  hygienic  laws  are 
broken,  and  will  give  an  idea  of  the 
customs  which  must  be  overturned  by 
the  doctor  if  he  is  to  have  any  great 
influence  upon  the  health  of  the  na- 
tion. 

I have  called  your  attention  to 
these  rather  unpleasant  facts  for  the 
reason  that  I want  you  to  see  how 
much  wider  is  the  need  for  educated 
doctors  and  nurses,  than  would  at 
first  appear. 

T was  sent  to  Turkey  in  1897  to 
build  a hospital  at  Marsovan  in  Asia- 
Minor  for  the  mission  stationed  at 
that  point.  During  the  first  year 
after  my  arrival,  while  constructing 
the  new  hospital,  for  temporary  use, 
we  rented  a native  house  of  five 


5 


rooms,  furnished  it  with  eight  mat- 
tresses spread  on  the  floor  and  a few 
dishes.  An  old  kitchen  table  did  duty 
in  the  operating  room,  flanked  by  a 
number  of  tin  kerosene  oil  cans  which 
we  used  as  sterilizers.  Still,  under 
such  conditions,  in  eight  months, 
ninety  major  operations  were  per- 
formed. 

By  the  third  year,  after  the  hospital 
had  become  an  established  fact,  we 
had  room  for  thirty-two  patients,  but 
our  beds  were  always  full  and  many 
patients  often  waited  weeks  for  ad- 
mission. In  order  to  make  room,  we 
were  obliged  to  put  two  children  to- 
gether in  one  bed,  with  their  heads 
sticking  out  from  each  end.  It  was 
at  this  time  I began  to  wonder  what 
would  be  the  end  of  such  strenuous 
work,  and  whether  it  was  worth 
while.  Hundreds  were  coming  to  the 
clinics  weekly ; we  were  operating  as 
often  as  possible,  and  still  were  only 
reachinof  about  one  out  of  every  ten 
of  the  sufferers  who  applied  to  us, 
while  we  knew  that  thousands  were 
dying  in  nearby  towns  for  lack  of  the 
care  we  were  giving  to  the  few. 

I was  often  told  that  the  medical 
man  in  foreign  lands  was  ruining  his 
health  and  throwing  away  his  life  in 
trying  to  accomplish  the  impossible ; 


6 


that  in  relievins:  suffering  and  ciirinsf 
a few  of  the  thousands  he  was  pro- 
ducing only  a ripple  on  a sea  of  mis- 
ery, which  would  die  down  as  soon  as 
he  was  exhausted.  It  was  thoughts 
like  these  that  started  me  planning 
some  method  by  which  we  could  reach 
the  many  and  brought  out  the  sug- 
gestion of  starting  a training  school 
for  nurses,  who  in  their  turn  could 
instruct  their  own  peonle.  However, 
I soon  found  that  the  idea  of  a native 
woman  performing  the  duties  which 
fall  to  a trained  nurse  was  such  a 
radical  change  from  the  customs  of 
the  country  that  I despaired  of  mak- 
ing it  a success. 

The  profession  was  unknown,  ex- 
cept for  the  three  or  four  foreign 
nurses  who  had  come  into  the  coun- 
try with  American  surgeons.  The 
care  of  the  sick  had  been  for  cen- 
turies left  to  servants,  and  such  serv- 
ice was  considered  mental.  For  these 
reasons  it  seemed  impossible  to  get 
educated  women  to  take  up  the  work. 

This  stumbling  block,  however,  was 
overcome  in  a providential  way 
through  a young  woman  from  a good 
family  whom  we  had  engaged  to  come 
to  the  hospital  as  interpreter  for  the 
English  nurses.  This  girl  had  a very 
lovely  character,  and  one  day  came 


7 


to  me  and  said  that  she  would  like  to 
become  a nurse.  I was  surprised,  as 
it  had  been  distinctly  stipulated  that 
she  was  not  to  be  asked  to  help  in  any 
way  with  the  manual  work  of  the  in- 
stitution, and  I was  also  afraid  that 
her  parents  would  object.  But  she 
was  staunch  in  her  resolution  and 
said  she  would  try  it  for  a year. 

This  was  the  beginning:  of  the  ex- 
periment, which,  if  successful,  was  to 
be  the  opening  of  a new  career  for 
women  in  Turkey,  and  might  also  be 
the  cause  of  changing  the  sanitary 
life  'of  the  nation.  The  girl  worked 
steadily,  but  every  time  she  went 
home  to  see  her  friends  she  had  a bat- 
tle to  fight.  All  her  family  consid- 
ered that  she  was  disgracing  them, 
and  tried  in  every  way,  except  by 
using  actual  force,  to  prevent  her  re- 
turn to  the  hospital.  At  the  end  of 
her  first  year,  I found  that  other  girls 
were  beginning  to  be  interested  in  her 
work.  I think  it  was  her  pretty  uni- 
form and  cap  that  first  attracted  their 
attention,  for  girls  are  girls  even  in 
Turkey.  But  whether  it  was  this  or 
the  love  which  every  woman  has  for 
helping  those  who  are  suffering,  be- 
fore the  end  of  the  second  year  a 
number  of  girls  had  offered  to  enter 
a training  class. 


8 


After  three  years  of  training, 
graduating  exercises  were  held,  and 
the  first  young  woman  was  given  a 
diploma.  This  greatly  stimulated  the 
interest  in  our  work,  and  from 
that  day  we  had  more  applications 
from  educated  girls  who  wished  to 
enter  the  training  school  than  we 
could  accept.  My  first  nurse,  after 
her  graduation,  was  made  assistant  to 
the  superintendent  of  the  hospital  at 
Marsovan,  and  she  is  working  there 
to-day,  one  of  the  few  native  women 
in  the  Turkish  Empire  who  stand  out 
above  their  environment. 

Of  course,  up  to  the  present  time 
very  few  girls  have  been  trained,  but 
enough  has  been  done  to  prove  that 
the  work  will  be  a success,  and  that 
for  many  years  to  come  the  supply 
of  nurses  will  not  equal  the  demand. 
Our  nurses  did  good  service  during  a 
fire  which  destroyed  a third  of  the  city 
of  Marsovan  three  years  ago.  Un- 
der the  direction  of  their  superin- 
tendent they  stood  near  the  fire  line, 
supplying  coffee  and  food  to  the 
workers  and  dressing  the  burns  and 
wounds  which  were  brought  to  them. 
This  proved  the  worth  of  our  train- 
ing, for  it  takes  a strong  character 
to  do  such  work  in  an  Oriental  crowd, 


9 


which  in  time  of  danger  is  very  much 
like  a mob. 

It  was  the  success  of  this  training 
school  and  the  many  requests  re- 
ceived for  nurses  which  made  it  im- 
perative to  enlarge  the  work,  and  it 
seemed  wise  to  place  the  new  school 
in  the  capital,  as  an  institution  there 
would  be  more  likely  to  have  a na- 
tional influence  upon  sanitary  affairs 
of  the  entire  country.  Two  years 
aeo  we  started  to  carry  out  this  plan, 
and  upon  the  eve  of  opening  our  new 
hospital  and  training  school  it  was 
destroyed  by  fire  with  all  its  contents. 

Although  this  seemed  at  the  time 
a great  disaster,  almost  without  delay 
we  secured  a new  fireproof  building, 
large  enough  to  accommodate  75 
patients  and  the  training  school. 
Here  we  are  now  carrying  forward 
the  work,  and  as  the  training  school 
grows  it  is  our  desire  to  start  a sys- 
tem of  district  nursing,  which  will 
gradually  bring  about  hygienic  re- 
forms, and  do  away  with  that  large 
part  of  disease  and  suffering  easily 
prevented  by  cleanliness  and  sanita- 
tion. 

This  system  we  hope  to  extend  in 
the  course  of  years  over  a large  part 
of  the  Turkish  Empire.  It  is  now 
only  a dream,  but  we  believe  it  can 


O 


be  made  to  come  true.  Already 
many  little  Turkish  children  have  had 
their  sight  saved  by  simply  impress- 
ing upon  their  mothers  that  flies 
carry  the  germs  of  trachoma.  I know 
of  families  where  formerly  one  child 
after  another  died  of  tuberculosis 
who  now  have  healthy  children  in 
their  homes  because  they  have  fol- 
lowed the  instruction  which  has  come 
from  our  medical  department. 

No  doubt  it  has  entered  the  minds 
of  some  here  that  I am  proposing  a 
herculean  task  which  cannot  be  per- 
formed, and  the  question  will  arise, 
“Can  you  change  the  customs  of  an 
Oriental  nation?”  T want  to  answer 
this  with  an  emphatic  “Yes,"  for  it 
is  being  proved  day  after  day  in 
every  Turkish  town  where  an  Ameri- 
can school  or  hospital  is  located.  If 
you  would  visit  a large  city  in  Tur- 
key where  this  work  has  not  begun, 
you  would  find  many  of  the  young 
girls  from  the  ages  of  12  to  15  mar- 
ried, and  staggering  under  the  re- 
sponsibilities of  motherhood,  while  in 
the  towns  where  these  institutions 
exist  many  girls  are  being  educated, 
with  little  thought  of  marriage,  before 
the  age  of  18  or  20,  while  some  are 
even  allowed  a voice  in  deciding  when 
that  event  shall  take  place. 


II 


The  practice  of  early  marriage  is 
one  of  the  most  deeply-rooted  cus- 
toms of  Oriental  people,  and  touches 
the  life  of  the  family  at  its  center.  If 
this  can  be  changed,  does  it  not  dem- 
onstrate that  when  once  these  people 
learn  that  their  habits  and  mode  of 
living  produce  disease  and  death  in 
their  children,  they  will  be  willing  to 
cast  them  aside? 

Not  only  families  but  officials  are 
awakening.  Only  a few  months  ago 
the  Governor  of  a large  city  spent 
considerable  time  with  me  discussing 
plans  for  protecting  the  water  supply 
in  his  district  from  infection,  and  I 
could  give  many  instances  to  prove 
that  a great  change  is  beginning  to 
take  place  in  the  hygienic  life  of  the 
nation. 


12 


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